Ajovia - Preventive Healthcare Made Simple

I hereby request that Quest Diagnostics and all partner imaging centers release to me—via Ajeris Inc. d/b/a Ajovia, as my authorized agent—all completed test results arising from my receipt of laboratory and imaging services ordered through the Ajovia platform (the "Results").

This includes:

All laboratory test results from Quest Diagnostics
All MRI and imaging results from partner imaging centers
All associated reports, interpretations, and digital files

Acknowledgments

I hereby acknowledge and accept that:

(a)

Either prior to or simultaneous with the communication of the Results to me, the Results will be communicated to the physician who ordered the tests (the "Ordering Physician");

(b)

The communication of the Results to me should not be viewed as medical advice and is not meant to replace direct communication with the Ordering Physician;

(c)

All inquiries regarding the meaning and/or interpretation of the Results should be directed to the Ordering Physician or my healthcare provider;

(d)

The communication of the Results does not include any information which would be consideration given for referrals, including medical advice specifically directed at me concerning my condition;

(e)

I consent to receiving Results electronically through the secure Ajovia platform;

(f)

This authorization remains in effect for all current and future tests ordered through Ajovia while I maintain an active account.

Important Information

Medical Advice Disclaimer

The release of test results through Ajovia is for informational purposes only. Always consult with your healthcare provider for medical advice, diagnosis, or treatment decisions based on your test results.

Result Delivery

Results will be delivered to your secure Ajovia dashboard typically within 3-7 business days of testing. You will receive an email notification when results are available.

Data Security

All results are transmitted and stored using industry-standard encryption. Your health information is protected in compliance with HIPAA regulations.

Signature

By signing below or providing electronic consent through the Ajovia platform, I authorize the release of my test results as described above.

Electronic Consent Option:

☑ I agree to this authorization and provide my electronic consent

Questions?

This form authorizes the release of your protected health information in accordance with HIPAA regulations and applicable state laws. Your authorization is voluntary and you may revoke it at any time by contacting us.